The Lives They Left Behind: Modern Psychiatry and the Mentally Ill

The New York Times Arts section had an article about an exhibit at the New York Public Library's Science, Industry and Business Library called "The Lives They Left Behind: Suitcases from a State Hospital Attic." The exhibit came about when hundreds of suitcases were discovered in an abandoned attic of New York's Willard Psychiatric Hospital. The suitcases contained personal items patients brought with them when they were admitted and the exhibit displays some of their belongings in addition to describing the life stories of nine patients. The curators have also written a book of the same name.

There is also an excellent companion website, http://www.suitcaseexhibit.org/. I read every page of the website and it got me thinking about my own experience working in mental health.

When people ask about my professional background, I usually start with “I have most of a Master’s Degree in psychology and I worked in community mental health for almost ten years.” While I regularly admit to leaving the field because I burned out, I rarely tell people how and why I burned out. It’s too long a story and it’s kind of a downer. To summarize the long story, I left because I realized I was working in a system that was broken and wasn’t interested in getting fixed. When I challenged the status quo, I was told that some day when I was more mature I would get it. I’m more mature now and I still don’t “get it.”

What I was supposed to learn was that psychiatrists know what’s best for patients and patients can’t be relied on to participate in their own care because they are “sick.” I came to realize that what “sick” meant to the experts was that patients don’t know who they are, what they need or have a right to an opinion about their treatment.

I have a crappy memory but I still vividly remember the case that showed me in stark relief the dysfunction of the system I was working in. Some day I will write the whole story but for now all you need to know is that I was doing 5150 evaluations on minors. 5150 is shorthand for the California state code that gives authorities the power to hold any one deemed “a danger to themselves, a danger to others or gravely disabled” (meaning they can’t do the basics to take care of themselves or keep themselves out of danger) for up to 72 hours. My job was to determine whether minors held under 5150 in Santa Clara County should go to a psychiatric hospital, home or another location. Hospitals were strongly discouraged because they cost the state and insurance companies money.

I’m proud of the work our team did. It was an important job and I know we made a positive difference in families’ lives. At the same time, I am ashamed of the system I worked in. I came to see that the poor and recent immigrants were over represented in the populations we evaluated. Many times what our clients needed was community support and understanding about their differences. When I took these concerns back to the older, white predominantly male psychiatrists with the final say in what happened, I ran into trouble. I was told the “patients” (who I considered “clients”) needed psychotropic drugs and weekly or bi-weekly talk therapy. Too bad there wasn’t any money for talk therapy. Interesting how there was just about always money for the elephant tranquilizers patients were deemed to need by those with medical degrees aka “Those Who Know More Than Common People.”

Okay, back to The Lives They Left Behind. I was moved to write this rather long post because the stories depicted on the website illustrate a couple of points about a broken system. First, the poor, minorities and immigrants were over represented in state run mental health hospitals. I say “were” because since we’ve shut down most mental health hospitals in the 1970’s, the mentally ill without excellent health insurance or rich families are left to the streets.

As if our treatment of who we deem mentally ill weren’t bad enough, the real horror story is lurking in the background. The Lives They Left Behind is an excellent example of how people with the title of Doctor are given sanction to hide behind the claim to be experts and are allowed to experiment on the vulnerable. From shock therapy, to ice baths to experimental medication, doctors sure of their own opinion were and are allowed to grind down the will and personalities of those in their care. And often when patients didn’t respond to experimental treatments the way they “should”, they were blamed for not giving the results the doctors had hoped for.

Did the doctors have good intentions? All of them think so. Some of them actually did. But that doesn’t excuse either the pious or the villainous. The real crime is when “experts” think they can and should enforce their opinion/will on those in their care. Good intentions are never enough when it comes to spiritual suffering.

What Does Selfish Mean to You?

Oprah has Elizabeth Berg, author of Eat Pray Love, on her show today and Elizabeth just mentioned that in Mandarin there are words for "Selfish." One means "doing that which is best for you" and the other means "hording, greedy or cruel."

When I was a child, the worst thing that could be said about me was that I was "selfish." My mother hurled the word like an epithet. "You are so SELFISH!"

I’m 40 years old now and in my stumblings to create a life worth living over the last 20 years, I’ve learned that “selfish” can be a good thing too. I don't always do what's best for me but I try. I am quite certain however that no one who knows me would accuse me of hording, greed or cruelty.